Provider Demographics
NPI:1295822682
Name:SIMONTON, AMANDA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LYNN
Last Name:SIMONTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LYNN
Other - Last Name:SIMONTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:9605 REDWING DR
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128-9392
Mailing Address - Country:US
Mailing Address - Phone:410-303-5068
Mailing Address - Fax:
Practice Address - Street 1:9605 REDWING DR
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-9392
Practice Address - Country:US
Practice Address - Phone:410-303-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003382363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical